JMIR Publications

ABSTRACT

Background:

Poor adherence to oral anticoagulants (OACs) in elderly patients with atrial fibrillation (AF) has been shown to negatively impact healthcare costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on healthcare providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening healthcare providers by using smartphone applications (i.e., app), but the use of the app for elderly patients with AF is still limited.

Objective:

The purpose of this study was to determine whether the new-developed smartphone application for AF patients (The Smart AF app) that integrates education, automatic reminder and patient engagement strategies with a simple user interface (UI) can improve medication adherence in elderly patients with AF.

Methods:

Patient enrollment was done by obtaining informed consent from AF patients attending Kyoto Prefectural University of Medicine hospitals between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient applications at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool.

Results:

A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 patients underwent follow-up at 1 month, 107 at 3 months, and 96 at 6 months. The mean age of the enrolled patients was 64.3 years, and males accounted for 79.4% (108/136) of the study population. The mean CHADS2 score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 and 10 patients were taking direct oral anticoagulants (DOACs) and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores. (all p values<0.01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows. 77.8% (14/18) of patients in the high adherence group (score=8) at baseline remained, 45.3% (24/53) of patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of patients in the low adherence group (score<6) moved to either the medium or high adherence group.

Conclusions:

The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using mobile health technology that emphasizes education, automatic reminder and patient engagement, may be helpful.